It’s International Day to End Obstetric Fistula

It’s International Day to End Obstetric Fistula

May 23 is marked globally as the International Day to end Obstetric Fistulaa hole in the birth canal caused by protracted, obstructed labour in the absence of timely medical care, leaving women to leak urine and faeces.

UNFPA describes the condition as a devastating childbirth injury to women who experience it, usually fatal to unborn babies (90 per cent of cases end in stillbirth) and – here’s the encouraging news – not only treatable but preventable.

Left untreated, it can lead to infection, disease and infertility. Sentenced to a life of misery, stigma and isolation – husbands and families abandon them, communities ostracize them, employment opportunities vanish – they can suffer from mental health issues and deepening poverty.

As the 2022 International Day to end Obstetric Fistula  is marked today, UNFPA says the condition has all but disappeared in rich countries but persists in poorer  countries with inadequate maternal health care. It says an estimated 500,000 women and girls live with the condition. Nigeria reportedly accounts for 40% of the worldwide fistula prevalence with approximately 20,000 new cases occurring each year,

UNFPA says: “Young bodies not ready for childbirth in cases of child marriage or unintended pregnancy are especially vulnerable. Women can develop fistula because they cannot afford transportation to a health facility or the services of a skilled birth attendant like a midwife. 

“The injury can be prevented by sexual and reproductive health care, access to contraception and access to skilled birth attendants and high-quality emergency obstetric care. With its many partners,

“UN Member States adopted a resolution to end fistula by 2030. To that end, the theme of this year’s observance is ‘End Fistula Now: Invest in Quality Healthcare, Empower Communities!’

“Obstetric fistula is a development and public health issue, but it’s also a human rights issue, one that grants everyone the right to health and a life of dignity.”

5 facts you should know about Obstetric Fistula by UNFPA

Patients at a VVF Centre in Jigawa State

1. There are different types of obstetric fistula 

While the most common type is a hole between the birth canal and bladder (called vesicovaginal fistula), other types include: 

  • Rectovaginal fistula: Hole between birth canal and rectum
  • Urethrovaginal fistula: Hole between birth canal and urethra (carries urine from bladder out of the body)  
  • Ureterovaginal fistula: Hole between birth canal ureters (carry urine to bladder) and birth canal
  • Vesicouterine fistula: Hole between bladder and uterus

Some fistulas are caused during gynaecological procedures (e.g. hysterectomy) and Caesarean sections due to substandard health care and inadequate surgical skills training/competence. These are called iatrogenic fistulas. Traumatic fistulas are caused by sexual violence, especially in conflict areas; the destruction of the vagina is considered a war injury. 

2. The physical, social and psychological consequences are devastating

The lives of women with the condition are defined by lifelong physical and emotional suffering.

The condition can lead to infections, ulcerations, kidney disease, painful sores, infertility and death. The smell from constant leakage isolates women who are often shamed and stigmatized, abandoned by their friends and families and ostracized by their communities. They suffer from depression and suicidal thoughts and other mental health issues. Denied livelihood opportunities, they are driven deeper into poverty and vulnerability.  

3. Young girls are particularly vulnerable 

While it does not discriminate by age, young girls are particularly vulnerable because their bodies may not be ready for childbirth. Nine in ten births to girls between the ages of 15 and 19 occur in marriage or union. Worldwide, pregnancy and childbirth complications are the leading cause of death among girls between the ages of 15 and 19. It’s just one more reason UNFPA works to eradicate the harmful practice of child marriage. 

4. It is rooted in poverty and gender inequality 

Obstetric fistula has all but disappeared in rich countries with quality health care systems and skilled professionals who can perform Caesarean sections. Midwives are a vital part of the solution. The International Confederation of Midwives states “ending obstetric fistula requires the full involvement of midwives  at the community, national, regional and global levels.” 

Apart from a lack of quality health services, poverty is a major social risk because it is associated with early marriage and malnutrition. Childbearing before the pelvis is fully developed as well as malnutrition, small stature and generally poor health conditions are contributing physiological factors to obstructed labour. However, older women who have already had babies are at risk as well.

In addition, because of gender inequality in many communities, women don’t have the autonomy or agency to decide when to start having children or where to give birth. 

Repair Surgery in progress in Sokoto State

5. It is treatable, but perhaps even more important, it is largely preventable

Up to 95 per cent of fistulas can be closed with surgery. A surgical repair costs $600, well beyond the reach of most women with fistula – if they’re even aware of the exact medical condition they have and that treatment exists. Through its assistance to countries and the Campaign to End Fistula, UNFPA has supported more than 121,000 life-changing repairs since 2003 and trained thousands of health workers to prevent and treat fistula.  

But before ever reaching the treatment stage, focus should be on prevention. Such measures include access to family planning skilled birth attendants and emergency obstetric care. Addressing societal factors that contribute to fistula – child marriage/early union and pregnancy, girls’ education, poverty and women’s lack of empowerment – is also part of the Campaign to End Fistula strategy. 

To have one’s life compromised for bringing forth new life is a devastating fate. But with awareness and will, the goal of eradicating the condition by 2030 is achievable.  

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